Factores que influyen en la satisfacción del paciente de diálisis con enfermería / Factors influencing the degree of satisfaction of the hemodialysis patient with nursing

Introducción: La satisfacción del paciente con los cuidados enfermeros se ha convertido en un determinante clave de la calidad de la atención sanitaria. Además, esto es especialmente relevante, sobre todo en pacientes crónicos, como es el caso del paciente con enfermedad renal crónica avanzada en hemodiálisis. Objetivo: Analizar los factores que intervienen en la satisfacción de los pacientes en hemodiálisis respecto al personal de enfermería. Metodología: Se ha llevado a cabo un estudio cualitativo, de tipo fenomenológico, mediante grupo focal de 7 pacientes en hemodiálisis de la Unidad de Gestión Clínica de Nefrología de Córdoba. Los sujetos fueron seleccionados mediante muestreo intencionado, tras su consentimiento informado. Resultados: Se han categorizado los resultados según las dimensiones de la calidad percibida. Respecto a la accesibilidad creen que son bien atendidos, pero pierden mucho tiempo en la unidad de diálisis. En cuanto a la fiabilidad, confían en las enfermeras con destreza para pinchar la fístula y desconfían de las enfermeras nuevas. Respecto a la comunicación, resaltan la buena relación existente entre ellos y el personal de enfermería. El trato es percibido como un punto fuerte, agradable y humano, en general. De forma generalizada destacan en las enfermeras un alto grado de competencia profesional, ligada al grado de fiabilidad que tengan con la enfermera. En general, califican el servicio asistencial que reciben de muy bueno e incluso excelente. Conclusiones: Este grupo de pacientes en hemodiálisis destaca la relación que se crea entre ellos y enfermería. Tienen un alto grado de confianza en el personal de enfermería, basado en su destreza para pinchar la fístula arteriovenosa y en su fiabilidad profesional (AU)

Introduction: Patient satisfaction with nursing care has become a key determinant of the quality of health care. In addition, this is especially relevant, especially in chronic patients, such as patients with advanced chronic kidney disease on hemodialysis. Objective: To analyze the factors involved in the satisfaction of patients on hemodialysis regarding nursing staff. Methodology: A qualitative, phenomenological study was carried out by focal group of 7 patients on hemodialysis of the Clinical Management Unit of Nephrology of Córdoba. Subjects were selected by intentional sampling, after their informed consent. Results: The results were categorized per the dimensions of perceived quality. Regarding accessibility, they believe that they are well taken care of, but they lose a lot of time in the dialysis unit. As for reliability, they rely on nurses who have the skill to puncture the fistula, and are wary of new nurses. Regarding communication, they highlight the good relationship between them and the nursing staff. The treatment is perceived as a strong point, pleasant and human in general. In general, nurses have a high degree of professional competence, linked to the degree of reliability they have with the nurse. In general, they rate the service they receive from very good and even excellent. Conclusions: This group of hemodialysis patients highlights the relationship between them and nursing. They have a high degree of confidence in the nursing staff based on their ability to puncture the arteriovenous fistula and in their professional reliability (AU)

[Conflicts of interest in nephrology]. / Conflictos de intereses en nefrología.

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation-ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.

Conflictos de intereses en nefrología / Conflicts of interest in nephrology

Since doctors disposed of effective tools to serve their patients, they had to worry about the proper management of available resources and how to deal with the relationship with the industry that provides such resources. In this relation­ship, health professionals may be involved in conflicts of interest that they need to acknowledge and learn how to handle. This article discusses the conflicts of interest in nephrology. Its objectives are to identify those areas where such conflicts could occur; to help to solve them, always considering the best interest of patients; and to help health workers to keep in mind that they have to preserve their autonomy and professional integrity. Conflicts of interest of professionals in the renal area and related scientific societies, with the industry producing equipment, supplies and drugs are reviewed. Dichotomy, payment for referral, self-referral of patients and incentives for cost control are analyzed. Finally, recommendations to help preserve a good practice in nephrology are made.

A comparison of the discursive practices of perception of patient participation in haemodialysis units.

BACKGROUND: According to Norwegian law, nurses are obligated to provide an acceptable level of health assistance to patients and their family members and to allow patients and their family members to participate in the planning of patient care and treatment. AIM: The aim of this study is to compare the perceptions of older patients undergoing haemodialysis treatment and of their next of kin and of nurses regarding patient participation in the context of haemodialysis treatment. RESEARCH DESIGN: The study adopts an approach that is both comparative and explorative in nature by examining the narratives of patients, nurses and next of kin and by performing critical discourse analysis as outlined by Fairclough. ETHICAL CONSIDERATIONS: Permission to carry out the research was granted by the Regional Committee for Medical and Health Research Ethics of Mid-Norway and by the participating hospitals. Informed consent and confidentiality were ensured. FINDINGS: Two discourses were found: (a) the discourse of paternalism with the discursive practices of achieving physiological balance in patients, trusting the healthcare team and being excluded or included in the difficult end-of-life decision-making process, and (b) the discourse of patient participation, with the themes of maintaining patients' quality of life and trusting patients. CONCLUSION: The participation of older patients and their next of kin was not as well integrated as social practice in dialysis units. The dominant discourse seemed to have an ideology and social practice of paternalism. However, there existed hegemonic struggles for an ideology of patient participation that involved (a) achieving physiological balance in patients versus maintaining patients' quality of life, (b) trusting the healthcare team versus trusting the patient, and (c) being excluded versus included in the difficult end-of-life decision-making process.

Vivenciando o tratamento hemodialítico pelo portador de insuficiência renal crônica / Viviendo la hemodiálisis por el portador de la insuficiencia renal crónica / Experiencing the hemodialysis by the bearer of chronic renal failure

Objetivo: compreender como o portador de Insuficiência Renal Crônica (IRC) percebe a doença e o tratamento hemodialítico. Métodos: estudo descritivo, com abordagem qualitativa com a utilização da Teoria Fundamentada nos Dados como referencial teórico-metodológico. O cenário do estudo foi uma unidade hemodialítica terceirizada que presta serviço ao Sistema Único de Saúde localizada no município de Montes Claros, Minas Gerais. Os dados foram coletados com 14 portadores de IRC através de entrevistas semiestruturadas. Resultados: identificaram-se três categorias: "Enfrentamento à hemodiálise: uma questão não resolvida"; "Espiritualidade e família" e "Expectativa em relação ao tratamento". Por meio das categorias, foi possível chegar ao fenômeno "Vivenciando o tratamento hemodialítico". Os discursos dos entrevistados evidenciaram formas diversificadas de enfrentamento à doença renal crônica e à hemodiálise. Alguns percebem a vida com grandes limitações. Outros enxergam no tratamento uma forma de manutenção da sobrevivência. Conclusões: o portador percebe as diversas modificações após a doença e que o tratamento dele é enfrentado positivamente quando o vê como uma forma de manutenção da vida; porém ele vê de forma negativa quando há sentimentos de dependência da máquina de hemodiálise e limitações. As expectativas acerca do transplante renal foram ambivalentes, uma vez que alguns manifestavam interesse em transplantar, enquanto que outros, por causas específicas, não vislumbram sua realização(AU)

Objetivo: comprender como la persona con insuficiencia renal crónica (IRC) en hemodiálisis percibe la enfermedad. Métodos: estudio descriptivo con enfoque cualitativo, con el uso de la Teoria Fundamentada en los Datos. El escenario del estudio fue una unidad de hemodialisis que brinda servicios de outsourcing para el Sistema de Salud en el município de Montes Claros, Minas Gerais. Los datos fueron recolectados con 14 personas con IRC a través de entrevistas semi-estructuradas. Resultados: la codificación y análisis de datos permitió la identificación de tres categorias. "Frente a la hemodiálisis: un problema no resuelto", "La espiritualidad y la familia" y "La esperanza en relación al tratamiento". Se puede llegar entonce s al fenómeno "Viviendo la hemodiálisis". Los discursos de los encuestados revelaron diversas maneras de hacer frente a la enfermedad renal crónica y hemodiálisis. Algun os ven la vida con grandes limitaciones. Otros ven una forma de tratamiento en el mantenimiento de la supervivencia. Conclusiones: el usuario percibe varios cambios después de la enfermedad y su tratamento; se enfrenta positivamente cuando lo ve como una forma de mantener la vida; sin embargo, es negativo cuando hay sentimientos de dependencia de la máquina de hemodiálisis y limitaciones. Las expectativas sobre el trasplante renal eran ambivalentes, porque algunos manifiestan cierto interés en el trasplante, mientras que otros, debido a causas específicas, no prevén su realización(AU)

Objetivo: comprender como la persona con insuficiencia renal crónica (IRC) en hemodiálisis percibe la enfermedad. Métodos: estudio descriptivo con enfoque cualitativo, con el uso de la Teoria Fundamentada en los Datos. El escenario del estudio fue una unidad de hemodialisis que brinda servicios de outsourcing para el Sistema de Salud en el município de Montes Claros, Minas Gerais. Los datos fueron recolectados con 14 personas con IRC a través de entrevistas semi-estructuradas. Resultados: la codificación y análisis de datos permitió la identificación de tres categorias. "Frente a la hemodiálisis: un problema no resuelto", "La espiritualidad y la familia" y "La esperanza en relación al tratamiento". Se puede llegar entonce s al fenómeno "Viviendo la hemodiálisis". Los discursos de los encuestados revelaron diversas maneras de hacer frente a la enfermedad renal crónica y hemodiálisis. Algun os ven la vida con grandes limitaciones. Otros ven una forma de tratamiento en el mantenimiento de la supervivencia. Conclusiones: el usuario percibe varios cambios después de la enfermedad y su tratamento; se enfrenta positivamente cuando lo ve como una forma de mantener la vida; sin embargo, es negativo cuando hay sentimientos de dependencia de la máquina de hemodiálisis y limitaciones. Las expectativas sobre el trasplante renal eran ambivalentes, porque algunos manifiestan cierto interés en el trasplante, mientras que otros, debido a causas específicas, no prevén su realización(AU)

Objective: To understand how the person with chronic renal failure (CRF) and realize the disease hemodialysis. Methods: It is a descriptive study with a qualitative approach with the use of Grounded Theory as theoretical and methodological reference. The study setting was a hemodialysis unit that provides outsourced services to the Health System in the municipality of Montes Claros, Minas Gerais. Data were collected with 14 CRF through semi-structured interviews. Results: The coding and data analysis allowed the identification of three categories. "Facing hemodialysis: an unresolved issue", "Spirituality and family" and "Expectancy in relation to treatment", being possible to reach the phenomenon "Experiencing the hemodialysis". The speeches of the respondents revealed diverse ways of coping with chronic kidney disease and hemodialysis. Some see life with great limitations. Others see a form of treatment in the maintenance of survival. Conclusion: It is concluded that the wearer perceives several changes after the disease and his treatment is positive when faced sees it as a way of maintaining life, but they see it as negative when there are feelings of dependence on hemodialysis machine and limitations. The expectations on renal transplantation were ambivalent, because some manifested interest in transplanting, while others, due to specific causes, not envisage its realization(AU)

Discapacidad intelectual y toma de decisiones en hemodiálisis: ¿exclusión u oportunidad? / No disponible

No disponible

Suspensión de terapia dialítica. Análisis de un problema ético-clínico / No disponible

No disponible

La opción sexual como tema de conflicto en la sala de diálisis / No disponible

No disponible

Necesidad de una información responsable sobre las modalidades de tratamiento renal sustitutivo / Need of responsible information on modalities of renal replacement therapy

No disponible

No disponible

Estudio de pacientes transeúntes en una unidad de hemodiálisis / Study of outpatients in a haemodialysis unit

Por la situación de nuestra unidad en un destino turístico importante, son muchos los pacientes que nos demandan tratamiento. Los enfermeros nos encontramos con retos añadidos al carácter ambulatorio del paciente como son el idioma, el diferente manejo terapéutico de los pacientes en diálisis de otros países y la falta de registros enfermeros que nos permitan poder desarrollar planes de cuidados que garanticen una continuidad en el plan terapéutico. El objetivo del estudio es caracterizar el tipo de pacientes transeúntes que recibieron tratamiento dialítico en nuestra unidad de hemodiálisis durante los meses de mayo-octubre en los años 2001 y 2002. Se ha realizado un estudio observacional, descriptivo y retrospectivo de una muestra total de 17 pacientes. Para la recogida de datos, se ha utilizado un registro de elaboración propia dividida en tres apartados: datos personales, pauta de diálisis y complicaciones intradiálisis. Un elemento que se hace necesario para garantizar la continuidad de los cuidados de enfermería es el registro para los pacientes transeúntes que debería acompañar a cada uno en sus desplazamientos a otras unidades de diálisis (AU)

Due to the location of our unit in an important tourist destination, there are many patients who ask us for treatment. Nursing staff face challenges in addition to the clinical nature of the patient, such as language, the different therapeutic handling of patients in dialysis in other countries and the lack of nursing registers to help us develop care plans to guarantee continuity in the therapeutic plain. The aim of the study is to characterise the type of outpatients who received treatment in our haemodialysis unit from May to October in the years 2001 and 2002. An observational, descriptive and retrospective study was made of a total sample of 17 patients. One of our own registers was used in the data collection, divided into three sections: personal data, dialysis tendency and intradialysis complications. One element that is necessary to guarantee the continuity of the nursing care is the outpatients register, which must accompany each person when they travel to other dialysis units (AU)

Entorno clínico de la enfermera de hemodiálisis en la provincia de Cádiz / Clinical framework for nursing in the district of Cadiz

A raíz de las investigaciones realizadas por la American Academy of Nurses sobre los denominados Hospitales Magnéticos (concepto introducido por L. Aiken), se puede afirmar que estos hospitales se caracterizan por: fomentar y permitir la autonomía profesional, el control sobre la práctica, tener una mejor relación con otros profesionales, y retener a enfermeras cualificadas que sean capaces de ejercer su juicio profesional en nombre de los pacientes. Los hospitales en los que existe una mayor satisfacción laboral de las enfermeras, presentan unos mejores resultados finales de los pacientes. El objetivo del presente estudio consiste en: determinar el grado de acuerdo de las enfermeras de hemodiálisis de la provincia de Cádiz con los atributos del entorno de la práctica enfermera (autonomía, relaciones enfermera médico, control sobre la propia práctica y apoyo de la organización). Se ha realizado un estudio de tipo cualitativo, descriptivo y multicéntrico dirigido a todos los profesionales enfermeros de la hemodiálisis de Cádiz. Los resultados obtenidos reflejan que la percepción que tienen las enfermeras de hemodiálisis de la provincia de Cádiz se alejan de los encontrados en otros estudios. Por todo ello proponemos el hospital magnético como instrumento para incentivar el desarrollo profesional y el entorno de trabajo (AU)

Based on the research done by the American Academy of Nurses on the so-called “Magnetic Hospitals” (concept introduced by L Aiken) we can establish that those hospitals are characterized by supporting professional autonomy, control on the practise mechanisms, a better relationship with other professionals, and keeping qualified nurses. Those hospitals where nurses feel more satisfied show better results with their patients. The aim of this work was to study the degree of satisfaction of nurses in Cadiz with their framework (including autonomy, relationship with doctors, control over their own practise, and support by the organizations). We have performed a qualitative, descriptive, multicentric study addressed to all nurses of haemodialysis in the District of Cadiz. The results show that the perception of these professionals is different from other studies. Therefore, we propose the magnetic hospital as an instrument to support the professional development and the work framework (AU)